| Light Of The Pines, Llc | |
|
1705a Feagin Dr # 164 Lufkin TX 75904-5535 | |
| (936) 875-4555 | |
| (936) 236-4715 |
| Full Name | Light Of The Pines, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1705a Feagin Dr # 164, Lufkin, Texas |
| Authorized Official Name and Position | Jennifer Ann Young (LICENSED ADMINISTRATOR) |
| Authorized Official Contact | 9368754555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Of The Pines, Llc Po Box 154735 Lufkin TX 75915-4735 Ph: (936) 875-4555 | Light Of The Pines, Llc 1705a Feagin Dr # 164 Lufkin TX 75904-5535 Ph: (936) 875-4555 |
| NPI Number | 1326614678 |
|---|---|
| Provider Enumeration Date | 05/27/2021 |
| Last Update Date | 05/27/2021 |
| Certification Date | 05/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326614678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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